Localization of the epileptic focus by low-resolution electromagnetic tomography in patients with a lesion demonstrated by MRI.

Patients with medically intractable partial epilepsy and well-defined symptomatic MRI lesions were studied using phase-encoded frequency spectral analysis (PEFSA) combined with low-resolution electromagnetic tomography (LORETA). Ten patients admitted to the epilepsy monitoring unit with MRI-identified lesions and intractable partial epilepsy were studied using 31-electrode scalp EEG. The scalp electrodes were located in three-dimensional space using a magnetic digitizer and coregistered with the patient's MRI. PEFSA was used to obtain a phase-encoded scalp map for the ictal frequencies. The ictal generators were obtained from the scalp map using LORETA. In addition, the generators of interictal epileptogenic spikes were identified using time-domain LORETA. The LORETA generators were rostral to the MRI lesion in 87% (7/8) of patients with temporal lobe lesions, but all were located in the mesial temporal lobe in concordance with the patients' MRI lesions. In patients with frontal lobe epilepsy, the ictal generators at the time that the spectral power was maximal localized to the MRI lesions. Eight of 10 patients had interictal spikes, of which 4 were bilateral independent temporal lobe spikes. Only generators of the interictal spikes that were ipsilateral to seizure onset correlated with the ictal generators. LORETA combined with PEFSA of the ictal discharge can localize ictal EEG discharges accurately and improve correlation with brain anatomy by allowing coregistration of the ictal generator with the MRI. Analysis of interictal spikes was less useful than analysis of the ictal discharge.

The practical utility of performing peri-ictal SPECT in the evaluation of children with partial epilepsy.

Peri-ictal brain single-photon emission computed tomography (SPECT) is increasingly being established as a useful test in localizing partial epilepsy in adults. However, obtaining an ictal injection and acquiring the SPECT images poses a greater challenge in pediatric patients, and few reports have specifically addressed the practical use of this technique in children. The Mayo Clinic experience of peri-ictal SPECT in the evaluation of children with partial epilepsy is reported here. Peri-ictal SPECT was attempted during 71 admissions involving 59 patients (median age 12 years, range 1 year 6 months-17 years). A peri-ictal SPECT injection was performed on 48 (67.6%) of these admissions in 43 (72.9%) patients, and only two patients could not be scanned. Of the 46 peri-ictal images successfully obtained, 30 (65.2%) were from ictal injection and 16 (34.8%) from post-ictal injections. Forty-two (91.3%) of the successfully obtained SPECT images, in 38 patients (92.3%), were classified as localizing (15 temporal, 24 extratemporal). We conclude that, with the appropriate unit setup and well-trained staff, peri-ictal SPECT scans can be obtained in most pediatric partial epilepsy patients. Moreover, the procedure provides specific localizing information in a high proportion of these patients.

Epilepsy education: a nursing perspective.

The nurse-clinician offers a unique perspective in the early education of patients with epilepsy. As part of the health-care team, the nurse assumes an important role in providing comprehensive epilepsy education. Epilepsy may occur at any time throughout life, and age-related needs necessitate ongoing assessment and intervention. The initial approach is to formulate an individualized educational plan of care. Financial, emotional, and cultural concerns should be discussed, and available support systems should be analyzed. The goal of epilepsy education is to provide the patient and family members with the informational tools needed to enhance their knowledge about epilepsy. The nurse can present a formal educational plan and schedule appointments to review the various aspects of self-management and reinforce their importance. Ultimately, this knowledge of epilepsy and the recommended treatment plan can lead to a greater sense of power and control necessary for self-management and an improved quality of life. By creating a foundation of trust with the patient, health-care providers can continue to monitor and manage the seizure disorder to attain optimal patient outcomes. This positive interaction with the health-care team will subsequently influence the patient's lifestyle in a beneficial manner.

Long-term electroencephalographic monitoring for diagnosis and management of seizures.

Long-term electroencephalographic (EEG) monitoring is the process of recording an EEG for a prolonged period in order to document epileptic seizures or other episodic disturbances of neurologic function. Indications for long-term EEG monitoring include diagnosis of a seizure disorder (epilepsy), classification of seizure types in patients with epilepsy, and localization of the epileptogenic region of the brain. Methods used for long-term EEG monitoring include prolonged analog or digital EEG, prolonged analog or digital ambulatory EEG, and prolonged analog or digital video-EEG monitoring with telemetry. Each of these methods has distinct advantages and disadvantages, particularly relative to storage, retrieval, and manipulation of data. Long-term EEG monitoring is useful in the management of patients with epilepsy and in the diagnosis of a seizure disorder. For most patients, inpatient long-term EEG monitoring is best performed in a specialized epilepsy-monitoring unit, which can provide a safe environment and both educational and psychosocial support. The choice of the most appropriate method of long-term monitoring for a specific clinical situation is best made by an epileptologist or a neurologist at an epilepsy center.

Interelectrode coherences from nearest-neighbor and spherical harmonic expansion computation of laplacian of scalp potential.

Interchannel coherence is a measure of spatial extent of and timing relationships among cerebral electroencephalogram (EEG) generators. Interchannel coherence of referentially recorded potentials includes components due to volume conduction and reference site activity. The laplacian of the potential is reference independent and decreases the contribution of volume conduction. Interchannel coherences of the laplacian should, therefore, be less than those of referentially recorded potentials. However, methods used to compute the laplacian involve forming linear combinations of multiple recorded potentials, which may inflate interchannel coherences. WE compared 3 methods of computing the laplacian: (1) modified Hjorth (4 equidistant neighbors to each electrode), (2) Taylor's series (4 nonequidistant neighbors), and (3) spherical harmonic expansion (SHE). Average interchannel coherence introduced by computing the laplacian was less for nearest-neighbor methods (0.0207 +/- 0.0766) but still acceptable for the SHE method (0.0337 +/- 0.0865). Average interchannel coherence for simulated EEG (random data plus a common 10 Hz signal) was less for laplacian than for referential data because of removal of the common referential signal. Interchannel coherences of background EEG and partial seizure activity were less with the laplacian (any method) than with referential recordings. Laplacians calculated from the SHE do not demonstrate excessively large interchannel coherences, as have been reported for laplacians from spherical splines.

Determination of 10-20 system electrode locations using magnetic resonance image scanning with markers.

We determined locations of 33 scalp electrodes used for electroencephalographic (EEG) recording by placing markers in the positions determined by the 10-20 system and performing magnetic resonance image (MRI) scanning on volunteer subjects. Small Vaseline-filled capsules glued on the scalp with collodion produced easily delineated regions of increased signal on standard MRI head images. Measurements of each capsule's coordinates in 3 dimensions were made from MRI scans. A spherical surface was fitted through the marker positions, giving an average radius and an origin (center of sphere). The coordinate axes were rotated to ensure that electrode Cz was on the z-axis and that the y-axis was oriented in the posterior-anterior direction. Two spherical (angular) coordinates were determined for each electrode. Spherical electrode coordinates for different subjects differed by less than 20 degrees in all cases. An average and standard deviation of the spherical coordinates were calculated for each electrode. Standard deviations of several degrees were obtained. The average spherical coordinates obtained were close to those expected on the basis of applying the 10-20 system of placement to an ideal sphere. These measurements provide data necessary for various analyses of EEG performed to help localize epileptic foci.